The effect of type of hip protector and resident characteristics on adherence to use of hip protectors in nursing and residential homes--an exploratory study

OBJECTIVES: To investigate the factors influencing the acceptability of hip protectors to residents of nursing and residential homes, especially the effect of hip protector type, and resident characteristics. DESIGN: A randomised controlled trial with 12 weeks follow-up. Participants were randomised to receive either Safehip or HipSaver hip protectors. SETTING/PARTICIPANTS: 109 residents aged 61 to 98 years from seven residential homes and two nursing homes in Northern Ireland. MAIN OUTCOME MEASURES: Percentage day-time use of the hip protectors over 12 weeks and ongoing use at 12 weeks. RESULTS: 42% (119/285) of residents invited to enter the study agreed to take part, and 109 started to wear the hip protectors. 43.1% (47/109) were still using them at 12 weeks. Mean percentage day-time use for all residents during 12 weeks was 48.6%. There was no significant difference in percentage day-time use (p=0.40), or use at 12 weeks (p=0.56) between the residents wearing Safehip and HipSaver protectors. Greater percentage daytime use of hip protectors was associated with being resident in a home for the elderly mentally infirm (75.1%, p相似文献   

Dosage for cost-effective exercise-based falls prevention programs for older people: A systematic review of economic evaluations

BackgroundFalls in older people is a global public health concern. Physical exercise is a useful and potentially cost-saving treatment option to prevent falls in older people.ObjectivesWe aimed to (1) summarize the research literature regarding the cost-effectiveness of exercise-based programs for falls prevention in older people and (2) discuss the implications of the review's findings for clinical practice and future research on the dosage of cost-effective exercise-based falls prevention programs for older people.MethodsMultiple databases were searched from inception until February 2019. Studies were included if they (1) were randomized controlled trials with an economic evaluation of exercise-based falls prevention programs for people ≥ 60 years old and (2) assessed the incremental cost-effectiveness ratios, cost per quality-adjusted life year, incremental cost per fall and benefit-to-cost ratio of programs. Methodological quality was assessed with the Physiotherapy Evidence Database scale and quality of economic evaluation with the Quality of Health Economic Studies.ResultsWe included 12 studies (3668 older people). Interventions for falls prevention were either exercise-only or multifactorial programs. Five studies of high economic quality and 2 of high methodological quality provided evidence supporting exercise-only programs as cost-effective for preventing falls in older people. Specifically, a tailored exercise program including strengthening of lower extremities, balance training, cardiovascular exercise, stretching and functional training of moderate intensity performed twice per week with each session lasting 60 min for ≥ 6 months delivered in groups of 3 to 8 participants with home-based follow-up appears to be cost-effective in preventing falls in older people.ConclusionThere is evidence to support exercise-based interventions as cost-effective treatment for preventing falls. Further research is needed to fully establish the cost-effectiveness of such programs, especially in both developing and underdeveloped countries.Review registrationPROSPERO CRD42018102892.     

Effect of hip protectors,falling angle and body mass index on pressure distribution over the hip during simulated falls

Background

We examined how a soft shell hip protector affects the magnitude and distribution of force to the hip during simulated falls, and how the protective effect depends on the fall direction and the amount of soft tissue padding over the hip.

Methods

Fourteen young women with either high or low body mass index participated in a “pelvis release experiment” that simulated falls resulting in either lateral, anterolateral or posterolateral impact to the pelvis with/without a soft shell hip protector. Outcome variables were the magnitude and location of peak pressure (d, theta) with respect to the greater trochanter, total impact force, and percent force applied to four defined hip regions.

Findings

The soft shell hip protector reduced peak pressure by 70%. The effect was two times greater in low than high body mass index individuals. The protector shunted the peak pressure distally along the shaft of the femur (d = 52 mm (SD 22), theta = −21° (SD 49) in the unpadded trials versus d = 81 mm (SD 23), theta = −10° (SD 35) in the padded trials). Peak force averaged 12% greater in posterolateral and 17% lower in anterolateral than lateral falls.

Interpretation

Our results indicate that the hip protector we tested had a much stronger protective benefit for low than high body mass index individuals. Next generation protectors might be developed for improved shunting of pressure away from the femur, improved protection during posterolateral falls, and greater force attenuation for low body mass index individuals.     

The need for a falls prevention programme for patients undergoing hip and knee replacement surgery

Falls are a major concern in the elderly consuming considerable healthcare resources. This study evaluates the incidence of falls in patients suffering osteoarthritis (OA) and their impact on health status. 199 patients awaiting primary hip or knee replacement surgery for OA were recruited (84 hips, 115 knees). Patients completed a questionnaire including the Western Ontario and McMaster University OA Index (WOMAC), Short Form 36 (SF-36), and history of falls. Function was measured using the Timed Up and Go (TUG) test. Seventy-five patients (39%) reported falling within a 4-week period with 50 (25%) having fallen more than once. Fallers had significantly lower WOMAC pain and function scores, slower TUG, and worse SF-36 scores excluding social functioning and mental health.This study demonstrates that patients with hip or knee OA frequently fall. Considering the increasing numbers of patients undergoing total knee and hip replacement for OA, and the catastrophic consequences of peri-prosthetic fractures, the need to incorporate a falls prevention programme within arthroplasty management requires evaluation.     

Exploring falls prevention capabilities,barriers and training needs among patient sitters in a hospital setting: A pilot survey

Older patients in hospitals are at high risk of falls. Patient sitters are sometimes employed to directly observe patients to reduce their risk of falling although there is scant evidence that this reduces falls. The primary aim of this pilot survey (n = 31) was to explore the patient sitters' falls prevention capability, self-efficacy and the barriers and enablers they perceived influenced their ability to care for patients during their shifts. Feedback was also sought regarding training needs. Most (90%) participants felt confident in their role. The most frequent reasons for falls identified were patient-related (n = 91, 64%), but the most frequent responses identifying preventive strategies were environment-related (n = 54, 64%), suggesting that the sitters' capability was limited. The main barriers identified to keeping patients safe from falling were patient-related (n = 36, 62%) such as cognitive impairment. However, opportunities that would enable sitters to do their work properly were most frequently categorized as being staff-related (n = 20, 83%), suggesting that the sitters have limited ability to address these barriers encountered. While 74% of sitters reported they had received previous training, 84% of participants would like further training. Patient sitters need more training, and work practice needs to be standardized prior to future research into sitter use for falls prevention.     

Effectiveness of an educational intervention on improving knowledge level of Chinese registered nurses on prevention of falls in hospitalized older people--a randomized controlled trial

Falls are highly prevalent in hospitalized older people. Although many factors contribute to this, registered nurses (RNs) lack of knowledge about how to prevent hospitalized older people falls was identified as one of the major factors. This study explored the effects of an educational intervention on improving knowledge level of RNs on prevention of falls in hospitalized older people. It was a randomized controlled trial. 374 RNs from 4 acute care hospitals in ChongQing were recruited to the study. Data were collected before the intervention and at the 3-month follow-up. After the intervention, knowledge scores increased significantly from baseline in the intervention group and significant differences were detected between the scores of the two groups at the 3-month follow-up. The results reflected that the educational intervention was an effective strategy for improving knowledge level of RNs on prevention of falls in hospitalized older people.     

Long-term follow-up of exercise interventions aimed at preventing falls in older people living in the community: a systematic review and meta-analysis

BackgroundFall-related injuries are the leading cause of accident-related mortality for older adults, with 30% of those aged 65 years and over falling annually. Exercise is effective in reducing rate and risk of falls in community-dwelling adults; however, there is lack of evidence for the long-term effects of exercise.ObjectivesTo assess the long-term effect of exercise interventions on preventing falls in community-dwelling older adults.Data SourcesSearches were undertaken on MEDLINE, EMBASE, AMED, CINAHL, psycINFO, the Physiotherapy Evidence Database (PEDro) and The Cochrane Library from inception to April 2017.Study selectionRandomised controlled trials (RCTs), cohort studies or secondary analyses of RCTs with long-term follow-up (>12 months) of exercise interventions involving community-dwelling older adults (65 and over) compared to a control group.Data extraction/ Data synthesisPairs of review authors independently extracted data. Review Manager (RevMan 5.1) was used for meta-analysis and data were extracted using rate ratio (RaR) and risk ratio (RR).ResultsTwenty-four studies (7818 participants) were included. The overall pooled estimate of the effect of exercise on rate of falling beyond 12-month follow-up was rate ratio (RaR) 0.79 (95% confidence interval (CI) 0.71 to 0.88) and risk of falling was risk ratio (RR) 0.83 (95% CI 0.76 to 0.92) Subgroup analyses revealed that there was no sustained effect on rate or risk of falling beyond two years post intervention.ConclusionsFalls prevention exercise programmes have sustained long-term effects on the number of people falling and the number of falls for up to two years after an exercise intervention.Systematic review registration numberCRD42017062461.     

Short-term effectiveness of a community-implemented falls prevention referral service

Purpose: To evaluate the effectiveness of the 16-week evidence-based Steady Steps exercise referral scheme at improving physical function, balance confidence, and quality of life (QoL) of community-dwelling older adults at risk of falling.

Method: A non-experimental, practice-based study involving a retrospective analysis of participant outcomes. Pre–post comparisons of three performance-based measures of gait and balance and of person-reported outcomes for balance confidence and QoL were performed. Effectiveness was evaluated in terms of statistically significant changes and relative to published fall-risk thresholds and minimal detectable changes (MDCs) or minimum clinically important differences.

Results: One hundred and thirty-six participants completed the program over 19?months. Statistically significant differences were observed for all outcomes (p?40% reported clinically important improvements in QoL.

Conclusions: While the non-experimental design precludes conclusive evidence of causation, the highly significant and clinically meaningful improvements observed in individuals who completed the evidence-based Steady Steps program support its translation of evidence into effective practice. Continued implementation and evaluation of such practices and their longer-term effects are warranted.

• Implications for Rehabilitation

• Falls in older adults represent an escalating public health problem, and rehabilitation professionals are charged with developing and/or identifying feasible and effective evidence-based programs that target and reduce falls risk in this population.

• Our findings support Steady Steps as an effective third-sector referral rehabilitation service that successfully translates research evidence-based exercise interventions into effective practice, positively impacting physical function, balance confidence and quality of life (QoL) in community-dwelling older adults.

• Our study provides practice-based evidence of the effectiveness of exercise interventions that are progressively challenging, deliver a high dose of moderate to high intensity and target the main falls risk factors of muscle weakness and gait and balance impairment.

• In spite of their limitations, non-experimental, practice-based approaches provide rehabilitation professionals with feasible opportunities for evaluating existing services, such as Steady Steps, and contributing to the overall evidence-base for falls prevention and management.

     

Evaluation of a peer-led falls prevention program for older adults

Waters DL, Hale LA, Robertson L, Hale BA, Herbison P. Evaluation of a peer-led falls prevention program for older adults.

Objective

To evaluate measures of strength and balance and falls incidence in participants attending fall prevention exercise classes taught by volunteer peer leaders, paid professional (Age Concern Otago group), or a comparison class (comparison group).

Design

Quasi-experimental evaluation with 12-month follow-up.

Setting

Community.

Participants

Older adults with increased fall risk (N=118; mean age, 75.5y; age range, 65–94y), with 23% drop out at 12 months.

Intervention

Peer-led group (n=52) and Age Concern Otago (n=41) weekly 1-hour strength and balance classes adapted from a home-based nurse/physical therapist–administered program and comparison group (n=25) 1-hour weekly seated exercise classes.

Main Outcome Measures

Timed Up and Go test, 30-second chair stand, functional reach, step touch, Single Leg Stand, and balance confidence at baseline, 10 weeks, and 6 and 12 months. Falls diaries collected monthly for 12 months. Continued exercise participation questionnaire at 6 and 12 months.

Results

At baseline, the peer-led group achieved normative standards on most tests and performed significantly better than the Age Concern Otago and comparison groups (overall P<.05). The Age Concern Otago group reached normative standards on most tests at 10 weeks. Functional improvements were similar in the peer-led group and Age Concern Otago groups from 10 weeks to 12 months, and all functional measures were significantly greater than in the comparison group (overall P<.02). Poisson regression showed a tendency for a 27% decrease in falls for the peer-led group compared with the comparison group (incidence rate ratio [IRR], .73; 95% confidence interval, .48–1.1; P=.07). Continued participation in strength and balance classes at 12 months was greater in the peer-led group and Age Concern Otago groups compared with the comparison group.

Conclusions

This peer-led model maintained measures of strength and balance and was superior to seated exercise. People in the Age Concern Otago group chose to continue these classes over other activities, whereas the comparison group had discontinued exercise classes by 12 months. Peer-led classes may decrease the fall incidence, although larger studies are needed to confirm this finding.     

The association between unexplained falls and cardiac arrhythmias: A scoping literature review

BackgroundFalls in older adults are common. Age is a risk factor for falls and with an ageing population, presentation to the emergency department (ED) resulting from falls is rising. Reasons for falls in older adults are numerous and include cardiac arrhythmias. However, older patients who present with falls do not appear to be routinely screened for cardiac arrhythmias.ObjectivesTo determine the association between cardiac arrhythmias and unexplained falls in older adults presenting to the ED and to identify the processes for cardiac screening in patients presenting to the ED after an unexplained fall.MethodsA scoping literature review was conducted because of the scarce number of primary research articles using an investigational design to undertake a detailed systematic review. Several databases were searched using the search terms: emergency department; trauma centers; arrhythmias cardiac; fall; and accidental fall.Data sourcesA structured and systematic search using MEDLINE, Embase, and PubMed was conducted from 2002 to December 2017.ResultsFive quantitative studies were included in this review that reported on adults who presented to the ED after an unexplained fall. Several factors associated with falls and cardiac arrhythmias were extracted from the data. These included age, past history of falls, current medications, comorbidities, electrocardiography, and other cardiac findings.ConclusionFalls in the elderly population account for a significant number of presentations to the ED. A number of known factors are associated with falls in elderly patients, including cardiovascular causes, yet specific individualised factors are largely unknown. There is no routine screening process for the identification of cardiovascular risk factors in those who present to the ED with an unexplained fall. Further research is needed to identify specific cardiac factors associated with the risk of unexplained falls in this patient cohort and to transfer these findings into a routine screening process.     

群组运动预防社区老年人跌倒效果的系统评价

目的评价群组运动预防社区老年人跌倒的效果。方法计算机检索中外数据库中关于群组运动预防社区老年人跌倒效果的随机对照试验,由2名研究者对文献进行质量的严格评价、资料提取,对符合质量标准的文献使用RevMan 5.3软件分析及描述结局指标。结果共纳入7项临床随机对照研究,3 608例研究对象。Meta分析结果显示群组运动能降低社区居住老人运动期间的跌倒发生率[RR=0.90(0.83,0.99),Z=2.20,P=0.03],可未能改善其生命质量[M=0.89(-3.05,4.84),Z=0.44,P=0.66]。结论现有证据证明群组运动有助于预防社区老年人跌倒。     

Six weeks of Pilates improved functional mobility,postural balance and spatiotemporal parameters of gait to decrease the risk of falls in healthy older adults

ObjectiveTo determine the effectiveness of Pilates exercises on falls risk factors.DesignProspective cohort, pre-test post-test study. Participants were selected using convenience and snowballing sampling. Pilates classes were held twice weekly for six weeks (1-h sessions) with a supplementary home programme.MethodsA test of cognitive function, the Montreal Cognitive Assessment (MOCA), was employed to determine eligibility for inclusion. The following fall-predictor variable measures were employed: the 16 item Falls Efficacy Scale (FES), the short International Physical Activity Questionnaire (IPAQ), the Functional Reach Test (FRT), the Timed Up and Go (TUG), the GAITRite® system, Platform FOOTWORKpro. Multivariate analysis ANOVA with time as within subject factor was used to test for differences between pre and post-test scores adjusted for the factor Pilates.Resultstwenty-seven participants completed the study, mean age = 70.4 (SD = 4.5). After adjusting for the effect of the factor Pilates “previous experience or no previous experience of Pilates”, statistically significant differences were identified in the following domains: The TUG (p < 0.001), FRT (p < 0.001), velocity, swing and stance time and the Mediolateral sway (p < 0.05). A significant difference was found between pre and post-test for anteroposterior sway in those with experience of Pilates (p < 0.05) and interaction between time and Pilates experience in Physical Activity (p < 0.05).ConclusionFindings suggest that functional mobility, mobility, spatiotemporal parameters of gait, postural balance and physical activity improved in healthy older adults after 6 weeks of Pilates with a supplementary home programme.     

Yoga’s effect on falls in rural,older adults

BackgroundUnintentional falls affect 30% of people over age 65 years. Yoga has been shown to improve balance. We designed this study to examine if yoga reduces falls.MethodsWe conducted 16 sessions of Hatha yoga over 8 weeks. Participants were randomly assigned to practice 10 min of yoga daily at home in addition to 5-min relaxation exercises or relaxation exercises only (control group).ResultsOf the 38 participants completing the intervention, 15 participants reported a total of 27 falls in the 6-months before the study, compared to 13 participants sustaining 14 falls in the 6 months from the start of the study (p < 0.047), without difference between yoga home-exercise and home relaxation-only groups.Compared to baseline scores, all participants improved on the Berg Balance Scale (53–54 out of 56, p = 0.002), the Functional Gait Assessment (22.9–25.8 out of 30 points, p < 0.001), and the Dynamic Gait Index (20.6–22.4 out of 24 points, p < 0.001). Right leg stand time improved from a mean of 13.3 s to 17.1 s (p = 0.020) and standing forward reach distance from 26.0 cm to 29.6 cm (p < 0.001). Without difference between groups.Confidence, with the Activities-specific Balance Confidence Scale, increased in the yoga home-exercise group (88%–93%, p = 0.037) compared to 90% unchanged from pre-intervention in the home relaxation-only group.ConclusionYoga classes reduce self-reported falls and improve balance measures. The addition of home yoga exercises did not enhance benefit over relaxation exercise only.     

层级管理中设立高级责任护士预防老年患者跌倒的效果

目的 探讨层级管理中设立高级责任护士对老年病区患者防跌倒的作用效果.方法 通过制定高级责任护士的选拔标准和考评办法,择优录用于老年内科临床护理,针对护理质量进行差异性分析.结果 设立高级责任护士后,患者跌倒发生率为0.40％,与设立高级责任护士前(3.60％)相比,差异有统计学意义(x2 =6.5,P＜0.01)；设立高级责任护士后患者满意度为98.0％,与设立高级责任护士前(88.0％)相比,差异有统计学意义(x2 =38.4,P＜0.01).结论 高级责任护士更重视住院患者存在的跌倒风险,能有效地避免跌倒意外事件的发生,确保住院安全,从而提高患者满意度.     

循证护理在预防老年精神病人跌倒的应用

目的 探讨循证护理在预防老年精神病人跌倒的应用,以减少住院老年精神病人跌倒的发生率.方法 通过循证支持,评估证据的有效性,结合临床专业分析及病人需求,依据证据,制定科学、有效的预防病人跌倒的护理干预措施,并对应用循证护理前、后病人发生跌倒率进行比较.结果 应用循证护理前病人跌倒发生率5.17%,应用循证护理后病人跌倒发生率2.23%.结论 应用循证护理能有效降低老年病人跌倒的发生率.